<!DOCTYPE html>
<html>
<head>
    <meta charset="utf-8" />
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <title>Page Title</title>
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <style>
        span{
            display:block;
        }
        input,textarea
        {
            display:block;
            outline:none;
            border: none;
            border-bottom: 1px solid rgb(191, 191, 191);
            /* margin: 10px; */
            color: #76838f;
            background-color: #6f2268;
            width: 95%;
            height: 36px;
            padding: 6px 15px;
            font-size: 14px;
        }
        textarea
        {
            height:100px;
        }
        select
        {
            width: 99%;
            display:block;
            outline:none;
            border: none;
            border-bottom: 1px solid rgb(191, 191, 191);
            /* margin: 10px; */
            color: white;
            background-color: #6f2268;
            /* width: 95%; */
            height: 36px;
            padding: 6px 15px;
            font-size: 14px;
        }
        option
        {
            background: white;
            color: black;
        }
        body{
            background-color: #6f2268;
        }
        span{
            text-align: left;
        }
        input::placeholder
        {
            color: white;
        }
        select
        {
            /* color: white;
            width: 100%;
            height: 36px;
            padding: 6px 15px; */
            /* font-size: 14px; */
        }
        textarea::placeholder
        {
            color: white;
        }
    </style>
</head>
<body>
    <div style="display:inline-block;width:40%;position:absolute;top:50%">
        <span style="font-size: 20px;
        color: rgb(255, 255, 255);">整形美容医院</span>
        <span style="color:rgb(191, 191, 191);font-size:16px">美丽热线：400-000-0000</span>
        <span style="color:rgb(191, 191, 191);font-size:16px">地址：中国地区XX分区人民中路88-66号</span>
        <span style="color:rgb(191, 191, 191);font-size:16px">邮箱：test@metinfo.cn</span>
    </div> 
    <div style="display:inline-block;width:50%;">
        <form>
            <input placeholder="姓名">
            <input placeholder="联系电话">
            <select >
                <option>咨询项目</option>
                <option>减肥丰胸</option>
                <option>眼部整形</option>
                <option>面部轮廓</option>
                <option>皮肤美容</option>
            </select>
            <textarea placeholder="留言"></textarea>
            <input placeholder="验证码">
        </form>
    </div>
</body>
</html>